FDA warns on mixing opioid addiction treatments, other meds

FILE - In this photo taken Oct. 14, 2015, file photo, the Food & Drug Administration campus in Silver Spring, Md. On Thursday, April 20, 2017, the Food and Drug Administration said they are strengthening warnings about the dangers of two types of powerful painkillers due to risks of slowed breathing and death. The FDA said it is requiring makers of prescription versions of the medicines, codeine and tramadol, to change the products' labels to warn against giving them to children under age 12, and to limit use in older children. The FDA also said breastfeeding women shouldn't take them because of possible harm to the baby. (AP Photo/Andrew Harnik, File)

The Food and Drug Administration issued new warnings Wednesday about the dangers of combining medication for opioid addiction with anti-anxiety medicines and other drugs that also slow breathing and brain activity.

The FDA warned that mixing such drugs can cause difficulty breathing, coma or death, so it should be done with caution.

The agency said a growing number of people fighting opioid addiction with methadone or buprenorphine also take other prescription drugs that slow action of the central nervous system. The warning lists several dozen brand-name and generic drugs that could be risky, including Ambien and Lunesta for insomnia, Valium and Xanax for anxiety, muscle relaxers Soma and Zanaflex and antipsychotic drugs Abilify, Invega, Saphris and others.

The agency stressed that treating opioid addiction with medication can outweigh those risks and is crucial to curbing the U.S. opioid epidemic, along with counseling, rehabilitation and other support.

“Careful management of the patient and coordination of care is recommended,” rather than denying use of methadone or buprenorphine, FDA Commissioner Scott Gottlieb wrote in a statement issued with the warning.

The FDA recommends that doctors develop detailed treatment plans, warn patients on addiction treatments about the dangers of taking multiple drugs that depress brain activity, try tapering them off those other drugs and monitor them with blood and urine testing.

Buprenorphine and methadone work by binding to the same brain areas as opioids, reducing cravings and withdrawal without producing a high. The FDA is requiring makers of those two medications to update their package inserts with information about the risks of using them with other drugs.